Neurological soft signs in patients with schizophrenia and their unaffected siblings: frequency and correlates in two ethnic and socioeconomic distinct populations

Recent studies have suggested that ethnicity and socioeconomic status may have an impact on the frequency and significance of neurological soft signs (NSS). However, this impact has not been adequately assessed. The objectives were to determine the NSS scores in patients with schizophrenia and their unaffected siblings and to examine the clinical and therapeutic correlates of NSS in two ethnic and socioeconomic distinct populations. Two independent replicate studies were carried out: (1) a French Caucasian sample of 69 patients with schizophrenia, 43 of their unaffected siblings and 108 control subjects; (2) a Tunisian sample of 66 patients with schizophrenia, 31 of their unaffected siblings and 60 control subjects. NSS were assessed with a multidimensional scale, previously validated in drug-naïve and treated samples of patients with schizophrenia. Both patient groups were assessed with the positive and negative syndrome scale (PANSS), the clinical global impressions (CGI) and the global assessment of functioning. NSS total scores were significantly higher in patients with schizophrenia comparatively to siblings and to controls in both studies. The two sibling groups had also higher NSS scores than controls. In addition, NSS total scores were correlated to the PANSS negative and disorganization sub-scores, to the CGI-severity of illness and to a low educational level in both studies. These studies provide a confirmation in two distinct samples of the high prevalence of NSS in patients with schizophrenia, and in their biological relatives, independently of their respective ethnic and socioeconomic origins.     

Neurological soft signs in schizophrenia patients with obsessive-compulsive disorder

Obsessive-compulsive disorder is a prevalent and clinically significant phenomenon in schizophrenia patients. Both schizophrenia and obsessive-compulsive disorder (OCD) are considered to be neurodevelopmental disorders sharing dysfunctional frontal-subcortical circuitry. Using the Neurological Evaluation Scale (NES), the authors assessed neurological soft signs in 59 patients who met DSM-IV criteria for both schizophrenia and OCD. The two schizophrenia groups (with and without OCD) scored higher than the comparison group but did not significantly differ from one another on any of the NES subscales. The first-episode patients in both groups scored similarly to patients with repeated hospitalizations on all NES subscales. Notably, the OCD patients scored similarly to the two schizophrenia groups on the NES motor sequencing subscale. The author's findings support the notion that neurological soft signs are independent markers of brain dysfunction detectable early in the course of schizophrenia. However, they are of limited value as a putative endophenotype in a search for specific etiological mechanisms underlying a schizo-obsessive subgroup of schizophrenia.     

Neurological soft signs in schizophrenia

Neurological Soft Signs (NSS) are defined as potential biological markers for schizophrenic disorders. There has recently been a renewer interest in its study. These NSS are not related to localized brain lesions, but it has been hypothesized that they reflect abnormalities in motor, sensory and integrative functions. It has been reported that schizophrenic patients exhibit NSS years before of the onset of psychotic symptoms and that they remain after recovery of that symptoms. Environmental and genetic causes have been involved in their origin. Different assessment scales have been developed in order to allow for comparisons between different studies and for relating NSS to clinical, psychopathological, neurocognitive, social and demographical variables of the disease. It has been demonstrated their relative independence of treatment and evolution of the disease.     

Neurological soft signs in never-treated schizophrenia

Objective: Studies of Neurological Soft Signs (NSS) in schizophrenia are confounded by handedness, inconsistent methodology, and prior treatment with neuroleptics. The study objective is to examine NSS in never‐treated schizophrenia. Method: We examined the NSS in treatment‐naïve schizophrenia patients (n = 21) and age, sex, education, and handedness matched normal controls (n = 21) using the modified Neurological Evaluation Scale with good inter‐rater reliability. Results: Schizophrenia patients had significantly more NSS than normals. No significant correlation was found between illness duration and NSS. Conclusion: Higher neurological signs in never‐treated patients and their lack of association with illness duration suggest neurodevelopmental etiopathogenesis of schizophrenia.     

Neurological soft signs in schizophrenia.

A new scale for neurological soft signs (NSS) was constructed and consists of 17 items compiled from the literature. The scale was found to have a high internal reliability (Cronbach's alpha 0.83) and a high interrater reliability (0.88). According to the results of a factor analysis, NSS are covered by five factors: 'motor coordination', 'integrative functions', 'complex motor tasks', 'righ/left and spatial orientation' and 'hard signs'. Using this scale, the associations of NSS with clinical course and brain alterations were investigated. NSS varied with the clinical course and were significantly correlated with some BPRS subscales, in particular 'thought disorder'. In addition, the 'motor coordination' soft signs were found to correlate with morphological alterations in the basal ganglia.     

Neurological soft signs and neurocognitive deficits in remitted patients with schizophrenia,their first-degree unaffected relatives,and healthy controls

European Archives of Psychiatry and Clinical Neuroscience - Neurological soft signs (NSS) and neurocognitive deficits (ND) are highly prevalent in schizophrenia, and have been separately proposed...     

精神分裂症神经系统软体征的系统综述

目的收集国内外2000年-2014年公开发表的关于精神分裂症神经系统软体征(neurological soft signs,NSS)的文献,综述精神分裂症NSS主要研究领域的最新研究成果,为今后研究精神分裂症NSS提供新的视角和相关理论依据。方法计算机检索Pub Med、Embase、中国知网以及万方数据库,检索精神分裂症神经系统软体征的相关文献。由2位评价员按纳入与排除标准筛选文献,评价纳入研究质量并提取原始资料后,综述精神分裂症神经系统软体征的主要研究成果。结果共检索到相关文献407篇,最终纳入25篇。结果显示精神分裂症NSS与精神分裂症阴性症状以及患者认知功能存在一定的相关性,NSS也渐渐显示出潜在的脑区皮层相关性,同时被认为是潜在的精神分裂症内表型之一。结论神经系统软体征对精神分裂症病理机制的确定具有一定的理论意义,同时对精神分裂症临床工作的完善具有指导作用;建议今后的研究对协变量做出更好的控制,拓展被试样本的年龄跨度,增加纵向研究和遗传学证据。     

Neurological soft signs and neuropsychological performance in patients with first episode schizophrenia

Neurological soft signs and neuropsychological (NP) impairments are prevalent in schizophrenic patients. However, the relationship of these deficits is rarely studied, and it remains controversial in what way soft signs influence NP performance. The Neurological Evaluation Scale (NES) and a comprehensive neuropsychological test battery were used to assess soft signs and cognitive functions in 61 first-episode schizophrenic patients. The NP test battery included tests such as the California Verbal Learning Test, the Continuous Performance Test, the Span of Apprehension Test, the Stroop Color-Word Test, the Trail-Making Test and the Wisconsin Card Sorting Test. The NP tests were also administered to 87 healthy controls. The first-episode schizophrenic patients were split along the median of their NES total score (SS- vs. SS+). The level of NP performance and the differences in relative performance (shape of the NP profile) on NP functions between the two groups were assessed. The two groups (SS- vs. SS+) did not differ in any demographic or clinical variable. However, they differed in the level of their NP performance (profile mean) but did not show differential deficits in NP performance (profile shape). Neurologic soft signs influence NP performance and are correlated to a generalized NP deficit rather than to any specific NP functions.     

Minor physical anomalies and neurological soft signs in patients with schizophrenia and their siblings

The aim of this study was to investigate the impact of lifetime posttraumatic stress disorder (PTSD), dissociation and a history of childhood trauma on quality of life (QoL) among men with alcohol dependency. A consecutive series of alcohol-dependent men (N = 156) admitted to an inpatient treatment unit were screened using the Michigan Alcoholism Screening Test, the Clinician Administered PTSD Scale, the Dissociative Experiences Scale, and the Childhood Trauma Questionnaire. QoL was assessed using the Medical Outcomes Study Short-Form 36-item health survey. Fifty (32.1%) patients had lifetime diagnosis of PTSD. Besides problems related to severity of alcohol use, the lifetime PTSD group was impaired on several physical and mental components of QoL. While the lifetime PTSD group and remaining patients did not differ on reports of childhood trauma and dissociation, in lifetime PTSD group, dissociative patients had higher scores of childhood emotional abuse than those of the non-dissociative patients. In multivariate covariance analysis, both dissociation and lifetime PTSD predicted impairment in physical functioning, general health, vitality, and mental health components of QoL. Among alcohol-dependent men with lifetime PTSD, a history of childhood emotional abuse contributes to impairment of QoL through its relationship with dissociation.     

Neurological soft signs in schizophrenia: Assessment and correlates

A German version of the Neurological Evaluation Scale (NES) was administered to 143 schizophrenic patients, 45 of them being severly chronic and disabled. Seventy-eight alcohol-dependent inpatients and 57 healthy volunteers were tested as control groups. Neurological soft signs (NSS) were rated with convincing agreement. Schizophrenic patients are more impaired on all scales than healthy controls. The chronic, severly disabled schizophrenic patients are more impaired compared with the main group of schizophrenic patients and both control groups. A significant patients and alcohol-dependent patients was only found for the subscale Motor Coordination. Compared with healthy controls the alcohol-dependent patients show a higher NES total score. The NES total score was related to the relative width of the third ventricle. Total score and subscales were correlated consistently with the level of cognitive functioning as measured by the Raven Standard Progressive Matrices and various neuropsychological tests presumably sensitive to dysfunctions of the prefrontal cortex. The NSS were related to positive as well as to negative symptoms, the correlations with negative symptoms being confined to items of Cognitive Disorganization. This close association of psychomotor and cognitive dysfunctions may be seen as related to the frequently discussed dysfunctions of the prefrontal cortex or the neurointegrative deficit postulated by Meehl.     

Neurological soft signs and dermatoglyphic anomalies in twins with schizophrenia.

Schizophrenia is associated with altered neural development. We assessed neurological soft signs (NSS) and dermatoglyphic anomalies (total a-b ridge count (TABRC) and total finger ridge count) in 15 pairs of twins concordant and discordant for schizophrenia. Within-pair differences in both NSS and TABRC scores were significantly greater in discordant compared to concordant monozygotic pairs. There was no significant difference in NSS and TABRC scores between subjects with schizophrenia and their co-twins without the illness. However, monozygotic discordant twins with schizophrenia had higher ABRCs on their right hands compared to their co-twins without the illness. These findings suggest that an unidentified environmental event acting between weeks 6 and 15 of gestation affects the development of monozygotic twins who go on to develop schizophrenia but does not have a corresponding effect on their co-twins who do not develop the illness. The effect of such an event on dermatoglyphic profiles appears lateralised to the right hand in affected twins.     

精神分裂症患者及其健康同胞注意力研究

目的：探讨精神分裂症患者的健康同胞有无注意力障碍。方法：采用倒行掩蔽测验，评估50例精神分裂症患者(患者组)及其健康同胞50名(同胞组)、正常对照者45名(对照组)的主动注意力和注意的激活度。结果：无掩蔽和有掩蔽刺激时，患者组的测验成绩均明显低于同胞组和对照组；靶刺激呈现后50毫秒出现掩蔽刺激时，患者组及同胞组的测验成绩明显低于正常对照组；其它条件下同胞组与对照组差异不显著。结论：精神分裂症患者有主动注意障碍和注意的激活度下降；精神分裂症患者的健康同胞也有主动注意力障碍，提示精神分裂症患者的同胞也有与精神分裂症患者类似的注意缺陷，主动注意缺陷可能是易患精神分裂症的危险因素之一。     

精神分裂症患者与健康同胞及正常人群认知功能的比较

目的:探讨精神分裂症患者与健康同胞及正常对照人群认知功能的特点。方法:采用数字划消测验(CT)、修订韦氏成人记忆量表(WMS-RC)、威斯康星卡片分类测验(WCST)对35例精神分裂症患者(患者组)、35例患者健康同胞(同胞组)及30例健康对照组(对照组)的认知功能进行测验。结果:患者组与同胞组记忆商数差异无统计学意义(P0.05);而与对照组记忆商数差异有统计学意义(P0.05)。在划消测验上患者组和同胞组指向与转移因子间差异有统计学意义(P0.05),而选择因子差异无统计学意义(P0.05);患者组和对照组在指向、转移与选择3个因子差异均有统计学意义(P0.05)。在WCST上患者组和同胞组持续时间数和持续错误数差异无统计学意义(P0.05),而分类完成数和总测验次数差异有统计学意义(P0.01);患者组与对照组比较,持续时间数、持续错误、分类完成数、总测验次数均差异有统计学意义(P0.01)。结论:精神分裂症患者及其健康同胞存在注意、记忆、执行功能方面的损害。     

Obstetric complications in patients with schizophrenia and their unaffected siblings.

OBJECTIVE: We sought to explore whether obstetric complications (OCs) are more likely to occur in the presence of familial/genetic susceptibility for schizophrenia or whether they themselves represent an independent environmental risk factor for schizophrenia. METHODS: The presence of OCs was assessed through maternal interview on 216 subjects, comprising 36 patients with schizophrenia from multiply affected families, 38 of their unaffected siblings, 31 schizophrenic patients with no family history of psychosis, 51 of their unaffected siblings and 60 normal comparison subjects. We examined the familiality of OCs and whether OCs were commoner in the patient and sibling groups than in the control group. RESULTS: OCs tended to cluster within families, especially in multiply affected families. Patients with schizophrenia, especially those from multiply affected families, had a significantly higher rate of OCs compared to normal comparison subjects, but there was no evidence for an elevated rate of OCs in unaffected siblings. CONCLUSION: Our data provides little evidence for a link between OCs and genetic susceptibility to schizophrenia. If high rates of OCs are related to schizophrenia genes, this relationship is weak and will only be detected by very large sample sizes.     

Neurological soft signs in patients with obsessive-compulsive disorder

Neurological soft signs (NSS) are minor neurological deviations signifying unspecific brain dysfunction. Several studies have reported an abnormally high prevalence of NSS in obsessive-compulsive disorder (OCD); however, the significance of their presence in OCD patients is not yet clear. We reviewed studies that investigated NSS in OCD patients, using a clinical examination or kinematical methods. In most studies, OCD patients showed an excess of NSS, especially in the areas of motor coordination, sensory integration and primitive reflexes. NSS in OCD patients may be associated with more severe obsessions as well as disturbances of visuo-spatial function and visual memory. Moreover, they may be already present at childhood, combined with anxiety disorders, thus possibly representing a marker of high risk for OCD. In conclusion, more studies are needed in order to assess both sensory and motor soft signs associated with OCD in a methodologically rigorous manner, to integrate the results with neuroimaging findings and to elucidate the role of NSS as markers of neuropsychological dysfunction in OCD.     

Neurological soft signs in schizophrenia and obsessive compulsive disorder spectrum

Obsessive compulsive symptoms are more frequent in patients with schizophrenia compared to normal population. Patients with obsessive compulsive disorder may also exhibit psychosis-like symptoms. Based on these findings, it has been suggested that there is a spectrum of disorders between OCD and schizophrenia. We compared two OCD groups (with good and poor insight) and two schizophrenia groups (with and without OCD) in this recommended spectrum especially in terms of neurological soft signs (NSSs) associated with sensory integration. The schizophrenia with OCD (schizo-obsessive) group exhibited worse performance than the schizophrenia group (p = 0.002) in only graphesthesia tasks. Moreover, schizo-obsessive patients exhibited worse performance compared to OCD patients in terms of graphesthesia (p = 0.001) and audiovisual integration (p = 0.001). Interestingly, OCD patients with poor insight tended to exhibit graphesthesia deficit in a similar manner to schizo-obsessive patients rather than OCD patients. According to our results, graphesthesia disorder is strongly associated both with OCD and schizophrenia. This suggests that neurodevelopmental disorders that lead to graphesthesia disorder overlap in comorbid OCD and schizophrenia patients.     

Neural anomalies during visual search in schizophrenia patients and unaffected siblings of schizophrenia patients

Schizophrenia patients and their unaffected first-degree relatives exhibit performance deficits on attention tasks, perhaps indicating genetic influence over attentional abnormalities in schizophrenia. To identify anomalous brain function associated with attention in individuals who likely have unexpressed genetic liability for schizophrenia, we studied electrophysiological characteristics of unaffected siblings of schizophrenia patients during a visual serial search task. We gathered behavioral and electrophysiological data from 19 schizophrenia patients, 18 unaffected biological siblings of schizophrenia patients, and 19 nonpsychiatric control participants during performance of the Span of Apprehension (Span) task and a control task. Schizophrenia patients had lower Span task accuracy than the other two groups. Schizophrenia and sibling groups exhibited diminished late positive potentials (P300) over parietal brain regions during Span trials. Compared to control task stimuli, attentional demands of Span stimuli elicited augmented early negative potentials (N1, P2) over posterior brain regions. The degree of augmentation was reduced in schizophrenia patients but not in siblings compared to control subjects. Unaffected siblings of schizophrenia patients appear to modulate early attentional functions of posterior brain regions more effectively than schizophrenia patients but show later electrophysiological anomalies suggestive of abnormal updating of task-relevant information. While the latter may reflect neural mechanisms predisposing performance deficits on attentional tasks, the former may reflect compensatory processes present in unaffected relatives of schizophrenia patients.     

Neurological soft signs in schizophrenic patients with obsessive-compulsive disorder

The purpose of this study was to examine neurological soft signs (NSS) in schizophrenic patients with obsessive-compulsive disorder (OCD). Neurological soft signs were assessed in 15 schizophrenic patients with OCD (OCD-schizophrenia), 38 schizophrenia patients without OCD (non-OCD-schizophrenia), and 24 healthy controls (HC) by means of the Neurological Evaluation Scale (NES). The OCD-schizophrenia group had significantly higher scores on total and subscales of 'sensory integration' and 'others' of NES than the HC group. Subscale scores of 'sequencing of motor acts' in-non-OCD-schizophrenia patients were significantly higher compared to OCD-schizophrenia patients. Total NES scores of both groups were significantly correlated with Scale for the Assessment of Negative Symptoms (SANS) scores. Only the subscale of 'sequencing of motor acts' was significantly correlated with SANS within the OCD-schizophrenia group. These results suggest that NSS do not significantly differ between schizophrenia patients with and without OCD, contrary to expectations. The NES scores in OCD-schizophrenic patients do not appear to be related to a more severe form of schizophrenia. Neurological signs and negative symptoms in schizophrenia patients with and without OCD may be considered as neurodevelopmental predisposing factors. Further research is required in schizophrenia patients with OCD to investigate the relationships between NSS and several neuroimaging or neuropsychological findings, constituting a subgroup within the schizophrenia spectrum.     

Neurological soft signs in first-episode schizophrenia: a follow-up study

OBJECTIVE: Neurological soft signs are frequently found in schizophrenia. They are indicators of both genetic liability and psychopathological symptoms. To further differentiate "trait" and "state" relations the authors compared the 1-year course of neurological soft signs in schizophrenia patients and comparison subjects. METHOD: Thirty-nine patients with first-episode schizophrenia spectrum disorders were examined after remission of acute symptoms and 14 months later. Established instruments assessed diagnoses, psychopathological symptoms, predictors of outcome, handedness, and neurological soft signs. Twenty-two age- and gender-matched comparison subjects were also examined twice. RESULTS: Neurological soft sign scores in patients were significantly elevated relative to comparison subjects at both measurement points. Whereas neurological soft signs remained stable in comparison subjects (time 1: mean=4.8, SD=3.3; time 2: mean=4.6, SD=3.9), they significantly decreased in patients (time 1: mean=15.7, SD=7.1; time 2: mean=10.1, SD=7.9). This effect was more pronounced in patients with a favorable versus a chronic course and was mainly accounted for by motor signs. Predictors of follow-up neurological soft sign scores were neurological soft sign levels at remission and compliance with treatment. CONCLUSIONS: Although neurological soft signs are intrinsic to schizophrenia, their level varies with the clinical course. Thus, neurological soft signs may correspond to both genetic liability and the activity of the disease process and may be considered as potential predictors of outcome.